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Thrombo-inflammatory prognostic score improves qSOFA for risk stratification in patients with sepsis: a retrospective cohort study

  • Dongze Li , Yisong Cheng , Jing Yu , Yu Jia , Bofu Liu , Yiqin Xia , Qin Zhang , Yanmei Liu , Yan Ma , Rong Yao , Zhi Zeng , Yu Cao and Shuyun Xu EMAIL logo
Published/Copyright: November 29, 2019
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 58 Issue 4

Abstract

Background

Both the thrombo-inflammatory prognostic score (TIPS) and the quick sequential (sepsis-related) organ failure assessment (qSOFA) are quick prognostic scores for sepsis during the early phase, while either of two scores has limited prognostic value for sepsis patients. This study aimed to evaluate whether TIPS adds more information of sepsis risk stratification for qSOFA.

Methods

This was a retrospective cohort study of patients with sepsis in the emergency department (ED). We performed a receiver-operating characteristic curve, integrated discrimination improvement (IDI), net reclassification improvement (NRI) and decision-curve analysis (DCA) analyses to investigate whether TIPS can improve qSOFA for risk prediction in patients with sepsis. The primary endpoint was mortality and the secondary endpoints were mechanical ventilation and admission to the intensive care unit (ICU) during the 28-day follow-up.

Results

We identified 821 patients with sepsis. We randomly assigned the patients’ data to a derivation group (n = 498; n = 112 died during the 28-days follow-up) or to a validation group (n = 323; n = 61). The addition of TIPS to qSOFA (T-qSOFA) improved the area under the curve (AUC) from 0.724 to 0.824 (p < 0.001) for predicting 28-day mortality. The discrimination improvement was confirmed by an IDI of 0.092 (p < 0.001). Addition of TIPS to the qSOFA resulted in a NRI of 0.247 (p < 0.001). The DCA showed that the net benefit of T-qSOFA was higher than that of TIPS or qSOFA for any threshold probabilities.

Conclusions

The prognostic value of qSOFA for patients with sepsis was enhanced by adding the TIPS score on admission for risk prediction in patients with sepsis during early phases in the ED.

Keywords: prognosis; quick sequential organ failure assessment (qSOFA); risk stratification; sepsis; thrombo-inflammatory prognostic score (TIPS)
Corresponding author: Prof. Shuyun Xu, MD, Department of Emergency Medicine, Laboratory of Emergency Medicine, West China Hospital, and Disaster Medical Center, Sichuan University, 37 Guoxue Road, Chengdu 610041, Sichuan, P.R. China, Phone: +86-28-85422288, Fax: +86-28-85422288
aDongze Li and Yisong Cheng contributed equally to this work.

  1. Author contributions: DL, SX and YJ conceived of the study design, analysed and interpreted the data, and drafted the manuscript. DL, JY, YC, YJ, YL, and YM contributed to collecting the data and performing the statistical analysis. BL, YX and QZ contributed substantially to interpreting the data and critically revised the manuscript for important intellectual content. RY and ZZ participated in the design of the study, acquired the data, and helped to revise the manuscript. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: This work was supported financially by grants from the Science Foundation of Science and Technology Department of Chengdu (Grant No. 2016-HM02-00099-SF) and Sichuan (Grant Nos. 2018RZ0139 and 2019JDRC0105), and 1•3•5 Project for Disciplines of Excellence-Clinical Research Incubation Project, Sichuan University West China Hospital (Grant Nos. 2018HXFH001 and 2018HXFH027).

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organisation(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

  6. Availability of data and materials: The datasets generated and analysed during the present study are available from the corresponding author on reasonable request.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2019-0864).

Received: 2019-08-15
Accepted: 2019-11-01
Published Online: 2019-11-29
Published in Print: 2020-03-26

©2020 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2019-0864
Keywords for this article
prognosis; quick sequential organ failure assessment (qSOFA); risk stratification; sepsis; thrombo-inflammatory prognostic score (TIPS)

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. New insights on the analytical performances for detecting and quantifying monoclonal proteins
  4. Reviews
  5. Vitamin C measurement in critical illness: challenges, methodologies and quality improvements
  6. Early predictors of perinatal brain damage: the role of neurobiomarkers
  7. Opinion Paper – Point
  8. Mixing studies for lupus anticoagulant: mostly yes, sometimes no
  9. Opinion Paper – Counterpoint
  10. Mixing studies for lupus anticoagulant: mostly no, sometimes yes
  11. EFLM Consensus Paper
  12. Quantifying atherogenic lipoproteins for lipid-lowering strategies: consensus-based recommendations from EAS and EFLM
  13. Guidelines and Recommendations
  14. PREDICT: a checklist for preventing preanalytical diagnostic errors in clinical trials
  15. Genetics and Molecular Diagnostics
  16. Plasma vs. serum in circulating tumor DNA measurement: characterization by DNA fragment sizing and digital droplet polymerase chain reaction
  17. General Clinical Chemistry and Laboratory Medicine
  18. An international multi-center serum protein electrophoresis accuracy and M-protein isotyping study. Part I: factors impacting limit of quantitation of serum protein electrophoresis
  19. An international multi-center serum protein electrophoresis accuracy and M-protein isotyping study. Part II: limit of detection and follow-up of patients with small M-proteins
  20. Use of clinical data and acceleration profiles to validate pneumatic transportation systems
  21. National survey on delta checks in clinical laboratories in China
  22. Assessment of the glomerular filtration rate (GFR) in kidney transplant recipients using Bayesian estimation of the iohexol clearance
  23. Performance of Afinion HbA1c measurements in general practice as judged by external quality assurance data
  24. Renal tubular epithelial cells add value in the diagnosis of upper urinary tract pathology
  25. Reference Values and Biological Variations
  26. Influence of ethnicity on biochemical markers of health and disease in the CALIPER cohort of healthy children and adolescents
  27. Cardiovascular Diseases
  28. Clinical evaluation of capillary B-type natriuretic peptide testing
  29. Infectious Diseases
  30. Thrombo-inflammatory prognostic score improves qSOFA for risk stratification in patients with sepsis: a retrospective cohort study
  31. Corrigendum
  32. Corrigendum to: Pediatric reference intervals for 29 Ortho VITROS 5600 immunoassays using the CALIPER cohort of healthy children and adolescents
  33. Letters to the Editor
  34. Potential risks in fecal microbiota transplantation
  35. Macro-aspartate aminotransferase syndrome: a case report
  36. Factitious severe acidosis in a patient, preanalytical considerations and prevention
  37. Methods for quick, accurate and cost-effective determination of the type 1 diabetes genetic risk score (T1D-GRS)
  38. Anti-adalimumab and anti-certolizumab antibodies titers after discontinuation of adalimumab: two case reports
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  40. Evaluation of PFA-100 closure times in cord blood samples of healthy term and preterm neonates
  41. Disagreement between direct and indirect potentiometric Na+ determination in infancy and childhood
  42. Carryover issues with UF-5000 urine flow cytometry – how did we miss it?
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